| NPI | 1780056002 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADEWUMI ADEDUNTAN Agent 832-818-1754 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: TX 2019839) |
| Additional Taxonomies | 302R00000X Health Maintenance Organization (Licence: TX 2019839) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2015-10-26 |